1 Introduction

Spinal cord injury (SCI) is a critical medical condition that frequently causes significant morbidity and lasting disability. It arises from the disruption of nerve axons in the spinal cord, resulting in the loss of motor and sensory function below the injury site. Typically caused by major trauma, the initial injury is often irreversible.¹ Spinal injuries, particularly those affecting the dorsolumbar region, pose considerable healthcare challenges, especially in regions with limited access to medical resources such as remote areas of Nepal.² The intricacies associated with the prevalence and characteristics of dorsolumbar spine injuries in these underserved regions necessitate a comprehensive examination. This descriptive cross-sectional study focuses on patients admitted to a provincial hospital in remote Nepal over a span of two years, aiming to elucidate the demographic profiles and injury patterns of individuals who underwent surgical interventions for dorsolumbar spine injuries (see Table 1).

2 Methods

A descriptive cross-sectional study was conducted among 200 patients admitted to Provincial Hospital of Remote Nepal Over Two Years. A descriptive cross-sectional approach was employed to analyze the demographics, mode of injury, level of spine injury, and ASIA classification of the cases. Convenience sampling was done. The sample size was calculated by using the formula:n=(Z2×p×q)/e2=(1.962×0.50×0.50)/0.072=196Where,n = minimum required sample sizeZ = 1.96 at 95 % of Confidence Interval (CI)p = prevalence taken as 50 % for maximum sample sizeq = 1-pe = margin of error, 7 %

A sample size of 196 was calculated and a total of 200 cases were taken. The data for this study was systematically collected from a pool of 200 cases admitted to a provincial hospital in remote Nepal over a period of two years, with a specific focus on dorsolumbar spine injuries. Employing a descriptive cross-sectional methodology, the research aimed to comprehensively analyze the demographic details, mode of injury, level of spine injury, and ASIA classification of the patients who underwent surgical interventions for dorsolumbar spine injuries.

To ensure the robustness of the study, a meticulous approach was adopted in data collection, involving thorough examination of medical records, diagnostic reports, and surgical intervention details. The demographic information included variables such as age, gender, and occupation. The mode of injury was categorized into specific types, including general falls, falls from height, falls from trees, falls of heavy objects, and road traffic accidents. The level of spine injury was precisely documented, distinguishing between dorsal spine, lumbar spine, dorsolumbar spine, and lumbosacral spine. Additionally, the ASIA classification was employed to classify the neurological status of the patients, differentiating between ASIA A, B, C, D, and E categories.³

Ethical considerations were prioritized throughout the study, ensuring compliance with relevant guidelines and obtaining necessary approvals from the institutional review board. The data analysis process involved the use of statistical tools to derive meaningful insights into the distribution and characteristics of dorsolumbar spine injuries among the study population. The systematic and comprehensive methodology employed in this study enhances the reliability and applicability of the findings in addressing the specific healthcare challenges associated with dorsolumbar spine injuries in remote Nepalese settings.

Data were collected and entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95 % Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data.

3 Results

Out of 200 cases admitted in the provincial hospital over two years, 56 (28 %) patients with dorsolumbar spine injuries were operated. Among them, 29 (51.8 %) were females and 27 (48.2 %) were males.

Analysis of the mode of injury demonstrated that falls from height constituted the majority of cases at 57.1 %, followed by road traffic accidents at 19.6 %, falls from trees at 14.3 %, and general falls and falls of heavy objects at 7.1 % and 1.8 %, respectively. The distribution of spine injury levels indicated a predominant involvement of the lumbar spine at 67.9 %, followed by the dorsal spine at 28.6 %. Dorsolumbar spine and lumbosacral spine injuries each accounted for 1.8 %. The ASIA classification highlighted that the majority of cases fell into the ASIA E category at 55.4 %, indicating normal neurological status. Other classifications included ASIA A at 30.4 %, ASIA C at 8.9 %, ASIA B at 3.6 %, and ASIA D at 1.8 %.

4 Discussion

Our study highlights the multifaceted aspects of dorsolumbar spine injuries observed in the provincial hospital of remote Nepal over the two-year study period. The balanced gender distribution among the operated cases, with a near-equal representation of females and males, underscores the importance of gender-neutral healthcare strategies in addressing dorsolumbar spine injuries. This finding emphasizes the need for comprehensive prevention and intervention measures that consider both genders, ensuring equitable healthcare outcomes.

The literature shows that in developed countries traumatic spinal cord injuries (SCIs) are more prevalent in males (79.8 %) than females (20.2 %).⁴ The age distribution shows two peaks, with one occurring between 15 and 29 years and a smaller but increasing peak in individuals over 50 years old.⁴

Falls rank as the second most common cause, contributing to 31 % of injuries during the same period, while sports-related injuries account for 10–17 % of traumatic SCIs. High-energy impacts, like those from traffic accidents and sports, are more prevalent in younger individuals, while low-energy impacts, such as falls, are disproportionately observed in individuals over 60 years, often associated with underlying spinal degenerative changes like degenerative cervical myelopathy.⁵

The incidence of cervical SCI is highest in the general population (60 %), followed by thoracic (32 %) and lumbosacral (9 %). The overall trend indicates a shift towards an older population experiencing traumatic SCIs, with traffic accidents and falls being significant contributors.⁴

The predominance of falls from height as the primary mode of injury, constituting 57.1 % of cases, signals the significance of safety measures in elevated work environments. The high proportion of injuries resulting from falls from trees (14.3 %) further highlights the diverse circumstances leading to dorsolumbar spine injuries in this population. The finding of this study coincides with published literature in which fall from height was seen in 43.7 % of the traumatic spine injury cases as the most common mode of injury followed by road traffic accidents (RTAs).⁶ Another similar study also showed fall from height seen in 44.12 % and fall from tree seen in 31.37 % to be the most common mode of injury.² These insights are crucial for developing targeted preventive strategies, including workplace safety initiatives and public awareness campaigns.

The distribution of spine injury levels provides valuable information for healthcare planning. The majority of cases involving the lumbar spine (67.9 %) suggest a higher vulnerability of this region to injuries. Some studies show predominance of dorsal spine injury over lumbar spine injury whereas some are in concordance with our findings.^2,6 This observation calls for focused efforts in preventive measures and educational campaigns to reduce the incidence of lumbar spine injuries, potentially involving occupational safety regulations and community-based interventions.

The ASIA classification analysis reveals a diverse spectrum of neurological statuses among dorsolumbar spine injury cases. The substantial representation of ASIA E cases (55.4 %), indicating normal neurological function, is a positive indicator of successful surgical interventions and rehabilitation. However, the presence of ASIA A cases (30.4 %), denoting complete sensory and motor loss below the injury level, underscores the challenges in managing severe dorsolumbar spine injuries. A study done over 15 years in Spain showed the burden of ASIA A class of spinal injury to be in the higher range in comparison and needed prolonged hospital stays, which is supported by a study done in Nepal as well.^7,8 This calls for continued efforts in improving surgical techniques, rehabilitation protocols, and postoperative care to enhance functional outcomes for patients with severe neurological deficits.

5 Conclusions

The comprehensive analysis of dorsolumbar spine injuries in a provincial hospital of remote Nepal over a two-year period sheds light on several critical aspects. The near-equitable representation of males and females undergoing surgical interventions emphasizes the importance of gender-neutral healthcare approaches in managing these injuries. The predominance of falls from height and trees as primary modes of injury underscores the need for tailored preventive measures, including workplace safety initiatives and public awareness campaigns. The insights gained from this study can inform targeted healthcare interventions, public health policies, and educational initiatives aimed at reducing the incidence of dorsolumbar spine injuries and improving the outcomes for affected individuals. Continued research and collaboration within the healthcare community are essential to refine and implement effective strategies that address the diverse challenges associated with dorsolumbar spine injuries in remote and underserved regions.

Consent

The purpose of this study was to investigate the epidemiology, surgical interventions, and outcomes of dorsolumbar spine injuries treated at a provincial hospital in Nepal. I would like to bring to your attention that the data for this study was collected retrospectively from the medical record section of the hospital. We obtained the necessary approvals from the hospital administration to access and utilize the patient data for research purposes.

It is important to note that no personal information of the patients was disclosed in the study, and no interventions were performed as part of the research. Furthermore, direct consent from the patients was not obtained, as this was a retrospective analysis of existing data from the hospital. Our research adheres to ethical guidelines, ensuring patient confidentiality and privacy throughout the study.

We believe that the findings of our research contribute valuable insights to the understanding and management of dorsolumbar spine injuries, particularly in the context of provincial healthcare facilities in Nepal. We trust that our manuscript aligns with the scope and interests of the Journal of Orthopedics and would greatly appreciate your consideration for publication.

Ethical statement

I am writing to affirm the ethical standards adhered to in the research presented in our manuscript entitled “Dorsolumbar Spine Injuries Operated in a Provincial Hospital of Nepal Over Two Years: A Descriptive Cross-sectional Study.” This correspondence is intended to provide the Journal of Orthopedics's editorial team with a clear understanding of the ethical considerations observed throughout the study.

Given the retrospective nature of our study, obtaining informed consent from individual participants was not feasible. However, we would like to clarify that this was a descriptive study involving the analysis of anonymized data extracted from medical records. As such, no direct interventions were conducted, and patient confidentiality was meticulously maintained throughout the research process.

The data was collected after approval from the hospital. The committee acknowledged the retrospective design of the study and the impracticality of obtaining individual informed consent. Any protocol modifications were reported and approved before implementation.

We ensured the confidentiality of participant information by employing de-identification methods during data analysis and reporting. Personal identifiers were carefully protected to prevent the disclosure of individual identities.

Authorship was determined based on substantial contributions to the conception, design, data acquisition, analysis, and interpretation of the study. All authors have reviewed and approved the final version of the manuscript and have agreed to its submission.

The authors declare no conflicts of interest, financial or otherwise, that could influence the interpretation of the data or presentation of the findings.

We trust that these ethical considerations align with the rigorous standards upheld by the Journal of Orthopedics. We appreciate your careful review of our manuscript and look forward to the opportunity to contribute to the scientific discourse through publication in your esteemed journal.

Finding statement

This original article titled “Dorsolumbar Spine Injuries Operated in a Provincial Hospital of Nepal Over Two Years: A Descriptive Cross-sectional Study” presents a comprehensive analysis of surgically treated dorsolumbar spine injuries in a provincial hospital of Nepal over a two-year period. The study, conducted without external funding or grants, was solely financed through personal funds, emphasizing the authors' commitment to advancing orthopedic knowledge in resource-constrained settings. The findings elucidate the epidemiology, surgical interventions, and outcomes of dorsolumbar spine injuries, shedding light on the unique challenges faced by healthcare providers in provincial settings.

Notably, this research adheres to ethical standards, with no conflicts of interest declared by the authors. The absence of external influences ensures the objectivity and integrity of the study's findings, reinforcing the credibility of the presented data. This submission to the Journal of Orthopedics aims to enrich the scientific literature, offering a significant contribution to the understanding and management of dorsolumbar spine injuries in the context of provincial healthcare facilities in Nepal.

CRediT authorship contribution statement

Bikash Kc: Conceptualization, Methodology, Software, Formal analysis, Resources, Formal analysis, Investigation, Project administration, Funding acquisition, Writing – review & editing. Badri Rijal: Conceptualization, Methodology, Software, Formal analysis, Resources, Formal analysis, Investigation, Writing – review & editing. Ravin Kc: Methodology, Software, Formal analysis, Investigation, Resources, Data curation, Writing – original draft, Writing – review & editing. Padam Giri: Methodology, Software, Formal analysis, Investigation, Resources, Data curation, Writing – original draft, Writing – review & editing.